Ch. 21

Creating an effective hybrid or integrated identity requires incorporating both ...

"military and civilian cultural knowledge, values and practices"

Identify the second S in Schlossberg's transition theory and can be described in terms of resources, or personal assets necessary for successful transition, and deficits, or liability serving as roadblocks to transition

Self

What is the philosophy shared by peer support programs

Self-direction, choice, and empowerment

Behavioral manifestations of moral injury may include...

Self-harm, social withdrawal, substance abuse, and social instability

Grief can result from any event that produces a significant disruption in __________, _________, and/or _________

Self-image, self-worth, and/or worldview

The transition to civilian life is further compounded by the disconnect between who

Service members and the general public

What is the term used to define life events or nonevents that require change, changes in relationships, assumptions, roles, and/or routines

Transitions

What is the term used to describe "a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force" according to the VA

Traumatic brain injury

True or False Although initial military training is designed to facilitate the transition into military culture, there is no corresponding mechanism to assist Veterans in successfully reintegrating into civilian life

True

True or False Although many military service members adjust seamlessly into civilian life, others struggle to transition back into family life, work, and community

True

True or False Compared to civilian populations with similar injury types, patients who received amputations reported higher functional outcomes than those with limb salvage

True

True or False Higher military rank was positively correlated with a lower probability of depression and PTSD and with a higher probability of working/on active duty or in school and being engaged in vigorous activities

True

True or False If a veteran is not able to or does not want to seek paid employment, volunteer works is a health-promoting alternative

True

True or False More intense combat experiences were associated with worse functional scores and a higher likelihood of PTSD

True

True or False Mental health conditions often present with medical comorbities

True Pain Hypertension Diabetes

The following events are examples of what type of transitions Divorce, premature death of a spouse, death of a child, natural and technological disaster, being laid off or fired from a job, war, and terrorism

Unanticipated transistions

What types of transitions are non-normative, have a low probability of occurrence, and often involve crisis - Outside of one's control and offer little or not opportunity to prepare - May occur at the individual, family, community, or societal level

Unanticipated transitions

OT practitioners have the knowledge and skills to do what for veterans

- Foster Veteran's engagement i health-enhancing occupations, habits, roles, and routines - Promote mental health - Enable occupational participation - Encourage community reintegration - Facilitate the recovery process

To work effectively with veterans, it is important to ...

- Understand military culture, the context of their overseas military culture, the context of their overseas military deployment, the physical and mental health conditions with which they return home, and the psychosocial stressors they experience

According to a study in the text, what are 4 factors that were associated with a more difficult readjustment experience when reentering civilian life

1. Being seriously injured in the line of duty 2. Serving in the military while married 3. Knowing someone who was killed or seriously injured in military service 4. Experiencing a traumatic event during military service

In order to repair moral injury and experience spiritual renewal, what 3 aspects of intervention appear to be useful

1. Emotional and psychological processing of the morally injurious event and its impact 2. Exposure to and participation in positive moral experiences, such as giving and receiving love and engaging in altruistic behaviors 3. Fostering reparation and the practice of forgiveness of self and others

The top three top-ranked interventions endorsed by occupational therapists for Veterans with PTSD are

1. Engaging in goal-directed meaningful occupations and activities 2. Developing occupational roles, habits, and routines 3. Meditating or using other mindfulness techniques

What were the top 5 physical health symptoms reported by those having difficult coping with grief

1. Fatigue 2. Sleep problems 3. musculoskeletal pain 4. Back pain 5. Headaches

Eligibility and health-care benefits requirements vary by whether or not the Veteran's disability is related to .... What 4 things?

1. Military service (service connection) 2. Period of service 4. Employment status 5. Income

Of the types of chronic pain, what 2 types have the highest prevalence in VA primary care settings

1. Musculoskeletal 2. Back pain

A survey indicated that the most significant challenges of the transition from military to civilian life are HINT: 4 things

1. Navigating VA programs 2. Benefits and services 3. Adjusting to civilian culture 4. Addressing financial challenges 5. Applying military -learning skills to civilian life

What are the 4 types of nonevent transitions

1. Personal 2. Ripple 3. Resultant 4. Delayed

It was determined that 2 elements directly influenced CR, what are they

1. Personal factors 2. Social support

In addition to the type of transition, additional factors determine the influence a transition has on a person's life. What are these 3 factors

1. Perspective 2. Context 3. Impact

What are the 4 terms used the describe the transition process under Schlossberg's transitions theory or "4S system"

1. Situation 2. Self 3. support 3. Strategies

Veteran identity is affected by what 3 things

1. Sociocultural factors 2. combat exposure 3. Time period (war era) in which the service occurred

A person's perception of and response to pain are influenced by the dynamic and reciprocal interactions of what 3 variables

1. biological 2. psychological 3. sociological

What are the 4 most common mental health diagnoses across all services

1. depressive disorders 2. anxiety 3. Insomnia 4. PTSD

What types of transitions are expected or hoped for events that did not occur - Alter a person's life and require change and adaptation

Nonevent transitions

Transitions can be

Normative, anticipated, and expected or unpredictable, unanticipated, and unexpected

According to the VA, ____ Veterans die each day by suicide

20

About half of active duty service members are _____ years of age or younger

25 years of age

On average, deployed personnel are under _____ years of age, more than _____ are married, and about ______ have children at the time of deployment

30 years old more than half about half

Meeting the needs of Veterans and their families begins with what

A comprehensive evaluation process Duhhhh

What is the first step in the process of the peer recovery support services

A conversation about the peer's values, interests, goals, and abilities

After sustaining a fracture from a blast injury, what happens next

Casualties are evacuated from the theater of operations, medically stabilized, and returned to a definitive care facility, where management may include amputation or limb salvage

What did the Uniformed Services University develop to address the need for culturally competent care for Veterans

Center for Deployment Psychology (CDP)

The primary underlying theme regarding reintegration transitions for families was the need for

Changes in family members' occupational performance patterns upon the service member's return

Veterans experience a disparity in health-care coverage on _______ and __________ ________

Age and employment status

The following events are examples of what type of transitions Graduation, marriage, starting a job, birth of a child, retirement

Anticipated transitions

What types of transitions are typically normative, meaning they predictably occur during the life course and the vast majority of people experience them - They are often self initiated and planned - There is usually time to prepare

Anticipated transitions

Social supports acted as _______ of CR HINT: Facilitators or barriers

Both

Identify the only occupation-based assessment that is demonstrated through research to be useful with Veterans who are in the provess of reintegrating into civilian life

COPM

What assessment was used in an interdisciplinary residential treatment program for Veterans with PTSD and TBI and was found to be effective in identifying each individual's unique set of goals and as an outcomes measure of the efficacy of treatment

COPM

According to the text, in a Delphi study that was conducted, what was the most highly supported FOR to be used for interventions with Veterans with PTSD What were 2 other theories identified as a result from this study

Canadian Model of Occupational Performance and Engagement (CMOP-E) MOHO and the recovery model

What is the term used to describe pain without biological value that has persisted past the expected time for tissue healing

Chronic pain

Veterans who reported a relatively easy transition back into civilian life were more likely to be

Commissioned officers, have a college degrees, and attend religious services at least once a week

Identify an assessment that consists of 15 questions designed to ascertain whether the person performs a certain activity alone or with another person - The higher the score, the greater the integration into the community

Community Integration Questionnaire (CIQ)

Identify the instrument specifically designed for Veterans, developed based on the International Classification of Functioning, Disability, and Health (ICF) and measures both objective and subjective aspects of participation - Consist of 3 scales: extent of participation, perceived limitations in participation, and participation satisfaction

Community Reintegration for Service Members assessment (CRIS)

Evaluation of community _________ is an important component of overall well-being and quality of life

Community integration

What term is used to define "returning to participation in home, social, and community living after deployment and in many cases, after injury as it relates to veterans

Community reintegration

What is the term used to define the desire to ameliorate the suffering of another

Compassion

The experience of positive emotions, particularly __________, ________, and ______ may assist in moral injury repair, increase cognitive flexibility, and promote social cohesion

Compassion, elevation, and pride

What is the term used to describe a "persistent and impairing condition, often in response to a traumatic death, that is characterized by intense emotional pain and sorrow, avoidance of reminders of the deceased, role and identify confusion, and a wish not to live without the deceased

Complicated grief (CG)

What is the primary contribution of the MOHO to the program at Veterans Recovery Resources

Concept of performance patterns and habituation

According to the Department of Veterans Affairs, the total Veteran population is predicted to ______ from 2017 to 2037 HINT: Increase or decrease

Decrease

What type of non-event transitions are those events that do not happen at the expected or desired time but are still hoped for and aspired to

Delayed nonevents

Military culture has been described as more ______ than most cultures, having an overt set of values and normative behaviors and a code of ethics supported by its own judicial system

Delineated

What is the term used to define "the movement of military personnel and equipment into places where they can be used when needed"

Deployment

Mental health assessments for Veterans should screen for what

Depression, anxiety, PTSD, and substance abuse

The majority of service members entered the military during what period of emerging adulthood

Developmental period

True or False Research has found that male Veterans reported poorer overall health, health-related functional limitations, and lifetime health conditions less frequently than civilian men

FALSE Research has found that male Veterans reported poorer overall health, health-related functional limitations, and lifetime health conditions MORE frequently than civilian men

What are some cognitive symptoms a veteran with a mTBI may experience

Difficulties with attention, concentration, and visuospatial abilities

What are some of the values the military culture emphasizes

Duty honor loyalty Discipline Readiness Accountability Dedication Commitment to comrades Unit cohesiveness

From an OT perspective, community reintegration is a ______ _________ process that facilitates participation in culturally appropriate and personally meaningful roles and full engagement in community life

Dynamice adaptation

What designated the beginning of Operation Enduring Freedom (OEF) or the "War in Afghanistan"

Military operations in Afghanistan beginning on October 7th, 2001

What is the term used to define the feeling of warmth one gets from witnessing human goodness or moral beauty

Elevation

Successful community reintegration is not simply a matter of individual function but also the readiness of a community to

Embrace Veterans and their needs

True or False Peer support specialists do not receive training or have to pass an exam to become certified

FALSE

True or False Healthcare for Veterans is guaranteed by military service alone

FALSE Healthcare for Veterans is NOT guaranteed by military service alone

True or False Peer support services are a substitute for professional care

FALSE Peer support services are a complement to professional care but NOT a substitute for it

Identify the tool under development that measures self-perceived difficulties with reintegration into civilian life

Military to Civilian Questionnaire

True or False Service members returning home without any physical injuries or diagnosable mental health disorders are not likely to be coping with a variety of psychosocial stressors that produce confusing, frustration, and distress

FALSE Service members returning home without any physical injuries or diagnosable mental health disorders ARE likely to be coping with a variety of psychosocial stressors that produce confusing, frustration, and distress

True or False Strength of social support was not a strong and consistent correlate of both physical and psychosocial functioning

FALSE Strength of social support WAS a strong and consistent correlate of both physical and psychosocial functioning

True or False Unremitting chronic pain decreases the risk of substance abuse, depression, and suicide among veterans

FALSE Unremitting chronic pain INCREASES the risk of substance abuse, depression, and suicide among veterans

Personal factors acted as _______ of CR HINT: Facilitators or barriers

Facilitators

What type of intervention practices helps to focus attention, increase body awareness, and enhance emotion egulation

Mindfullness

What type of intervention practices include sitting and walking meditations and yoga

Mindfulness

A study stated in the text, postulates that experiences of moral injury may disrupt the coherence and stability of a Veteran's sense of _______ ______

Global meaning

______ ______ era (1990-present) veterans now comprise the largest demographics of the veteran population

Gulf War-era

The prevalence of mental health conditions among Veterans is much ______ (higher/lower) than in active-duty military service members and civilian populations

Higher

Veterans often hold themselves to ______ (higher/lower) standards than the typical civilian

Higher

Challenging transitions for Veterans during reintegration include...

Leaving behind a built in support system, a steady income, and accessible resources

What are some factors associated with chronic pain in both Veteran and civilian populations

Lower levels of education, smoking, and emotional distress

What group of the population has the highest rate of suicide

Male veterans ages 18-34

What is one goal of occupational therapy interventions within this population is

Maximized the person-environment fit to enhance quality of life

What is the term used to describe "having attention paid to you, having a sense of importance, being appreciated, having people who depend on your, and having pride in what you do"

Meaning

According to the Defense Health Agency, the prevalence of active duty service members diagnosed with any mental health condition varies by ______ _____ and has ______ (increased/decreased) from 2005-2012 with a reported _______ (incline/decline) from 2013-2016

Military force Increased from 2005-20012 with a reported decline from 2013-2016

What is the term used to define the sense of the self as being good, competent, and virtuous

Pride

What term refers to the consequence of "perpetrating, failing to prevent, bearing witness to acts that transgress deeply held moral beliefs and expectations"

Moral injury

_______ ______ is a "broad clinical concept that exists in the intersection of multiple emotional, cognitive, and social pathways"

Moral injury

What is the term used to define a state in which a person or group of people are unable to do what is necessary and meaningful in their lives due to external restrictions

Occupational deprivation

What is the term used to define when a person's normal pattern of occupational engagement is disrupted due to significant life events - Typically temporary ad can occur due to a variety of situations

Occupational disruption

What is the term used to define when a person is unoccupied, underoccupied, or overoccupied

Occupational imbalance

In mid-2002, Congress signed into law authorization for the use of military force against the Saddam Hussein regime in Iraq, resulting in __________ _______ ______, also know as the "War in Iraq"

Operation Iraqi Freedom (OIF)

What are 2 of the major risk factors for suicide among Veterans that are identified in the text

PTSD and depression

PTSD and moral injury have common characteristics; however, what is the difference in how they are emotionally characterized

PTSD is emotionally characterized by fear Moral injury is emotionally characterized by shame

What term is used to describe a person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills in behavioral health settings to promote mind-body recovery and resiliency

Peer support specialists

What type of non-event transitions are those individual aspirations that are not realized Ex. never marrying or having a baby or not being promoted

Personal nonevents

What term is used to describe "two or more injuries to physical regions or organ systems one of which may be life threatening, resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability"

Polytrauma

What was the signature injury of the wars in Iraq and Afghanistan

Polytrauma

The _______ _______ of mild traumatic brain injury (mTBI), chronic pain, and PTSD have proven to be a difficult diagnostic and therapeutic challenge for the current medical system

Polytrauma triad

What did the VA administer to financially assist Veterans transitioning to student status and provides significant financial educational benefits, including full tuition and fees, a monthly housing allowance, and up to $1,000 a year to use for books and supplies

Post-9/11 GI Bill

What type of non-event transitions are the result of some event that occurs that causes an aspiration of expectation to remain unfulfilled - Has a begining and an end, but the nonevent lasts a lifetime Ex. not graduating from college because of an acquired brain injury due to an automobile crash

Resultant nonevents

What type of non-event transitions are personal nonevents of people close to us that require us to change or adapt Ex. a spouse not receiving a promotion at work

Ripple Nonevents

Identify the first S in Schlossberg's transition theory, that consist of 7 variables: trigger, timing, control, role change, duration, previous experience, and concurrent stress

Situation

What kind of disturbances are highly correlated with suicide among veterans, making it a priority for interventions

Sleep disturbances

Existing research indicates that successful recovery occurs when facilitated by _____ _____ within the context of the community

Social support

Identify the fourth S in Schlossberg's transition theory, that are the coping resources available to the person as he or she moves through the transition The coping strategies can be health enhancing or detrimental

Strategies

Rather than focusing on correcting deficits, disabilities, or problems, peer recovery support services incorporate what kind of approach to build resiliency and capacity

Strengths-based approach

Identify the third S in Schlossberg's transition theory, that refers to the encouragement, assistance, and options that are available in the environment

Support

What is the name of the national non-profit organization that deploys Veteran volunteers on specific projects for up to 6 months. - Designed to promote career and educational development

The Mission Continues

What was established to provide an integrated network of specialized rehabilitation programs dedicated to serving Veterans and service members with both combat- and civilian-related TBI and polytrauma

The VHA Polytrauma System of Care

What is the mission of the CDP

To lead the development of a community of culturally mindful and clinically competent providers through the delivery of high-quality training and education, the convening of experts, and the dissemination of research-based treatment and the latest topics in military behavioral health

What is the term used to define a "Veteran's self-concept that derives from his or her military experience within a sociohistorical context"

Veteran Identity

Understanding the differences of Veteran ________ should better inform community health promotion programming, resulting in improved health outcomes

Veteran culture

What is the model created to address the policy-institutional-, departmental,- and individual-level actions necessary to create an environment supportive of student Veterans that will lead to degree completion

Veteran-Friendly Environment Model

50% of Veterans live within 10 states, with the largest concentration residing in the _______ and _______ HINT: North, east, west, or south

West and south

Military cultural competence is essential to carrying for the __________ needs of military and Veteran populations

biopsychosocial

The majority of combat casualties are the result of a ______ injury

blast injury

Identify the term used to describe "ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3-6 months, and which adversely affects the the individual's wellbeing

chronic pain

The process of training for the armed services strips away a person's ________ ________

civilian identity

Chronic pain is considered a complex ___________ condition and therefore must be addressed hollistically

complex biopsychosoial

Because the military has its own culture, with a distinct set of values and norms significantly different from mainstream society, the community reintegration (CR) could be considered a _______ -_____ transition, making it ___________ and highly complex

cross-cultural transition making it multidimensional

Exposure to the death of an FSM was associated with _____ the rate of complicated grief when compared to other losses

double

Toblin et al. indicated that it was the _________ _______ of ________, rather than the actual experience of loss, that was associated with diminished physical health

emotional reaction of grief

69% of all Veterans suicide deaths are by _____

firearms

What are some physical symptoms a veteran with a mTBI may experience

headaches, pain, vestibular problems, and hearing and vision impairments

Other than the cognitive and physical symptoms, what other problems may a veteran with a mTBI experience

higher unemployment than counterparts without TBI and moderate to severe sleep disturbances

What kind of injury is characterized by loss of consciousness for 0 to 30 minutes, altered mental state of a moment up to 24 hours, post-traumatic amnesia of 0 to 1 days, and a Glasgow Coma Scale score of 13 to 15 in the first 24 hours

mTBI

Veterans often reflect on their military service as a time that fostered

personal maturation, teamwork and collaboration, and self-confidence

One strategy for assessing the community is through the use of ...

the PRECEDE-PROCEDE planning model

One of the most commonly reported organizational barriers to CR was the difficulty encountered when

when trying to access federal programs and services